Arthroscopic surgical device

ABSTRACT

An arthroscopic surgical device for tunneling through hard tissue including an arcuate tunneling needle driver and a bone engagement element, the arcuate needle driver and the bone engagement element being joined together to provide a joined needle driver and bone engagement element having at least two different operative orientations including an arthroscopic operative orientation wherein the joined arcuate needle driver and bone engagement element has a trans-incision insertion cross-sectional footprint and a tunneling operative orientation suitable for tunneling, wherein the joined arcuate needle driver and bone engagement element has a tunneling cross-sectional footprint which is substantially greater than the insertion cross-sectional footprint.

The present application is a continuation application of U.S. patentapplication Ser. No. 15/665,838, filed Aug. 1, 2017, entitledARTHROSCOPIC SURGICAL DEVICE, now U.S. Pat. No. 10,111,655, which is acontinuation application of U.S. patent application Ser. No. 14/240,227,filed Apr. 9, 2014, entitled ARTHROSCOPIC SURGICAL DEVICE, now U.S. Pat.No. 9,763,659.

REFERENCE TO RELATED APPLICATIONS

Reference is made to the following U.S. Provisional Patent Applicationswhich are believed to be related to the present application, thecontents of which are hereby incorporated by reference herein andpriority of which is hereby claimed under 37 CFR 1.78(a)(4) and (5)(i):

U.S. Provisional Patent Application Ser. No. 61/636,751, entitled“Circular Bone Tunneling Device Employing a Stabilizing Element” andfiled Apr. 23, 2012;

U.S. Provisional Patent Application Ser. No. 61/584,267, entitled“Circular Bone Tunneling Device” and filed Jan. 8, 2012; and

U.S. Provisional Patent Application Ser. No. 61/526,717, entitled“Circular Bone Tunneling Device” and filed Aug. 24, 2011.

Reference is also made to Published PCT Patent Application No. WO2012/007941, entitled “Circular Bone Tunneling Device” and filed Jul.11, 2011, the contents of which are hereby incorporated by referenceherein.

FIELD OF THE INVENTION

The present invention relates generally to arthroscopic surgical devicesand more particularly to arthroscopic bone tunneling devices.

BACKGROUND OF THE INVENTION

Various types of arthroscopic surgical instruments are known for variousapplications including orthopedic surgery.

SUMMARY OF THE INVENTION

The present invention provides an arthroscopic surgical device fortunneling through hard tissue.

There is thus provided in accordance with a preferred embodiment of thepresent invention an arthroscopic surgical device for tunneling throughhard tissue including an arcuate tunneling needle driver and a boneengagement element, the arcuate needle driver and the bone engagementelement being joined together to provide a joined needle driver and boneengagement element having at least two different operative orientationsincluding an arthroscopic operative orientation wherein the joinedarcuate needle driver and bone engagement element has a trans-incisioninsertion cross-sectional footprint and a tunneling operativeorientation suitable for tunneling, wherein the joined arcuate needledriver and bone engagement element has a tunneling cross-sectionalfootprint which is substantially greater than the insertioncross-sectional footprint.

There is also provided in accordance with another preferred embodimentof the present invention an arthroscopic surgical device for tunnelingthrough hard tissue including an at least partially flexible arcuatetunneling needle driver and a bone engagement element, the at leastpartially flexible arcuate tunneling needle driver including a needlepushing element which is capable of assuming an arcuate orientationduring needle driving operation thereof.

Preferably, the at least partially flexible arcuate needle driver andthe bone engagement element are joined together to provide a joinedarcuate needle driver and bone engagement element, the joined arcuateneedle driver and bone engagement element having at least two differentoperative orientations including an arthroscopic operative orientationwherein the joined arcuate needle driver and bone engagement element hasa trans-incision insertion cross-sectional footprint and a tunnelingoperative orientation suitable for tunneling, wherein the joined arcuateneedle driver and bone engagement element has a tunnelingcross-sectional footprint which is substantially greater than theinsertion cross-sectional footprint.

Preferably, the trans-incision insertion cross-sectional footprint issuitable for arthroscopic insertion and the tunneling cross-sectionalfootprint is not suitable for arthroscopic insertion.

In accordance with a preferred embodiment of the present invention thebone engagement element is a rotatable bone engagement element.

In accordance with a preferred embodiment of the present invention thearthroscopic surgical device for tunneling through hard tissue alsoincludes a bone engaging pin driving assembly including an elongate boneengaging pin. Additionally, the bone engaging pin includes a taperedscrew threading.

Preferably, the arcuate tunneling needle driver includes ahand-engageable ratchet handle arranged for reciprocal motion about anaxis and a selectable direction ratchet gear shaft.

In accordance with a preferred embodiment of the present invention thearthroscopic surgical device for tunneling through hard tissue alsoincludes an arcuate tunneling needle.

Preferably, the arcuate tunneling needle driver includes a flexibleneedle driving strip and a generally rigid flexible needle driving stripdriving shaft, mounted at a rear end of flexible needle driving strip.

In accordance with a preferred embodiment of the present invention thearthroscopic surgical device for tunneling through hard tissue alsoincludes an arcuate needle storage and guiding portion, formed with anarcuate bore. Additionally or alternatively, the arthroscopic surgicaldevice for tunneling through hard tissue also includes a bone engagementelement positioning assembly including a finger-engageable releasetrigger, finger engageable bone engagement element advancement knobs anda hollow bone engagement element driving shaft.

Preferably, the arthroscopic surgical device for tunneling through hardtissue also includes a needle and suture mounting assembly.

In accordance with a preferred embodiment of the present invention thearthroscopic surgical device for tunneling through hard tissue alsoincludes a bone suture insertion assembly including a looped suture anda tensionable resilient elongate element connected to the looped suturefor selectable tensioning of the looped suture.

There is further provided in accordance with yet another preferredembodiment of the present invention a bone suture insertion assembly foruse with an arthroscopic surgical device for tunneling through hardtissue, the assembly including a looped suture and a tensionableresilient elongate element connected to the looped suture for selectabletensioning of the looped suture.

There is even further provided in accordance with still anotherembodiment of the present invention an arthroscopic surgical method fortunneling through hard tissue including providing an arthroscopicsurgical device including an arcuate tunneling needle, an arcuatetunneling needle driver and a rotatable bone engagement element, joiningthe arcuate tunneling needle driver and the rotatable bone engagementelement to provide a joined needle driver and bone engagement elementhaving multiple different operative orientations, mounting a suturemounting assembly, including a suture, onto the arthroscopic surgicaldevice, inserting a forward portion of the arthroscopic surgical devicethrough an incision such that the forward portion engages the hardtissue, extending the arcuate tunneling needle through the hard tissue,engaging a forward end of the suture with the arcuate tunneling needleand retracting the arcuate tunneling needle through the hard tissue,thereby pulling the suture through the hard tissue.

Preferably, the multiple different operative orientations include atleast an arthroscopic operative orientation wherein the joined arcuateneedle driver and bone engagement element has a trans-incision insertioncross-sectional footprint and a tunneling operative orientation suitablefor tunneling, wherein the joined arcuate needle driver and boneengagement element has a tunneling cross-sectional footprint which issubstantially greater than the insertion cross-sectional footprint.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood and appreciated from thefollowing detailed description, taken in conjunction with the drawingsin which:

FIGS. 1A & 1B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a firstoperative orientation;

FIGS. 2A & 2B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a secondoperative orientation;

FIGS. 3A & 3B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a thirdoperative orientation;

FIGS. 4A & 4B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a fourthoperative orientation;

FIGS. 5A & 5B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a fifthoperative orientation;

FIGS. 6A & 6B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a sixthoperative orientation;

FIGS. 7A & 7B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a seventhoperative orientation;

FIGS. 8A & 8B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in an eighthoperative orientation;

FIGS. 9A & 9B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a ninthoperative orientation;

FIGS. 10A & 10B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in a tenth operative orientation;

FIGS. 11A & 11B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in an eleventh operative orientation;

FIG. 12 is a simplified exploded view illustration of the arthroscopicsurgical device of FIGS. 1A-11B in the first operative orientation;

FIGS. 13A and 13B are simplified exploded view illustrations of aportion of the arthroscopic surgical device of FIGS. 1A-12, showingopposite views;

FIG. 13C is a simplified partially assembled view of the portion of thearthroscopic surgical device of FIGS. 13A and 13B;

FIGS. 14A and 14B are simplified illustrations of another portion of thearthroscopic surgical device of FIGS. 1A-12, showing opposite views;

FIGS. 15A and 15B are simplified exploded view illustrations of theportion of the arthroscopic surgical device of FIGS. 14A & 14B, showingopposite views;

FIGS. 16A and 16B are simplified illustrations of part of the portion ofthe arthroscopic surgical device of FIGS. 14A-15B, showing oppositeviews;

FIGS. 17A and 17B are respective exploded and assembled views of part ofthe portion of the arthroscopic surgical device of FIGS. 14A & 14B;

FIG. 17C is a sectional illustration of the part of the portion of thearthroscopic surgical device of FIGS. 17A & 17B, taken along lineXVIIC-XVIIC in FIG. 17B;

FIG. 18A is a pictorial illustration of another part of the portion ofthe arthroscopic surgical device of FIGS. 14A & 14B;

FIG. 18B is a sectional illustration of the part of the portion of thearthroscopic surgical device shown in FIG. 18A, taken along lineXVIIIB-XVIIIB in FIG. 18A;

FIGS. 19A, 19B and 19C are simplified illustrations of one alternativefunctionality for mounting of a suture on a resilient loop which is inturn mounted on a forward portion of the arthroscopic surgical device ofFIGS. 1A-12;

FIGS. 20A, 20B and 20C are simplified illustrations of anotheralternative functionality for mounting of a suture on a resilient loopwhich is in turn mounted on a forward portion of the arthroscopicsurgical device of FIGS. 1A-12;

FIGS. 21A, 21B, 21C, 21D, 21E, 21F, 21G, 21H, 21I, 21J, 21K, 21L, 21Mand 21N are respective simplified illustrations of displacement ofvarious part of the arthroscopic surgical device of FIGS. 1A-20C duringoperation thereof; and

FIGS. 22A, 22B, 22C, 22D, 22E, 22F, 22G, 22H, 22I, 22J, 22K, 22L, 22Mand 22N are simplified illustrations of operation of the arthroscopicsurgical device of FIGS. 1A-21N in a clinical context.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Reference is now made to FIGS. 1A & 1B, which are simplified pictorialillustrations of an arthroscopic surgical device constructed andoperative in accordance with a preferred embodiment of the presentinvention, showing opposite views in a first operative orientation, andto FIG. 12, which is a simplified exploded view illustration of thearthroscopic surgical device of FIGS. 1A-11B.

As seen in FIGS. 1A, 1B and 12, an arthroscopic surgical device 100according to a preferred embodiment of the present invention includes ahousing portion, preferably formed of right and left housing elements102 and 104, and a multiple action driving assembly 106. The housingportion includes a handle portion, which is defined by respective rightand left housing element handle portions 112 and 114, respectively.

The multiple action driving assembly 106 preferably includes abone-engaging pin driving assembly 120 preferably including a knurledknob 122 and an elongate bone-engaging pin 124, extending forwardlytherefrom, having a pointed forward end 126 which may be formed with atapered screw threading 128.

The multiple action driving assembly 106 preferably includes ahand-engageable ratchet handle 130 which is arranged for reciprocalmotion about an axis 132 defined by a shaft 134. A selectable directionratchet gear shaft 135 extends through slots 136 in respective right andleft housing element handle portions 112 and 114, and terminates inknobs 146, whose positions in slots 136 govern the direction of motionof an arthroscopic arcuate tunneling needle 148 having a sutureengagement groove 149, which is fully described hereinbelow withreference to FIGS. 15A and 15B.

The multiple action driving assembly 106 also preferably includes a boneengagement element positioning assembly 150, including afinger-engageable release trigger 152, finger engageable bone engagementelement advancement knobs 154, a hollow bone engagement element drivingshaft 156 and a rotatable bone engagement element 158, pivotably mountedonto a transverse pin 160 (FIG. 17A) mounted onto a forward end 162(FIG. 22C) of driving shaft 156 for pivotable displacement about an axis164 (FIG. 17A) defined by pin 160. Hollow bone engagement elementdriving shaft 156 and rotatable bone engagement element 158 are shown intheir respective fully retracted orientations in FIGS. 1A, 1B and 12.

Disposed forwardly of housing elements 102 and 104 is a needle andsuture mounting assembly 170 including a suture 172, which removablyengages, at a forward end 174 thereof, a groove 176 in rotatable boneengagement element 158 and is mounted, at a rearward end thereof, via aresilient suture mounting element 182 and a suture mounting adaptor 183onto a groove 184 in a mounting base 185, which is fixedly mounted ontohousing portions 102 and 104.

A finger-engageable suture mounting adaptor release lever 186 is mountedonto housing portions 102 and 104 via a pin 187 and is operative whendepressed to cause suture mounting adaptor 183 to disengage from groove184 and thus from engagement with mounting base 185.

First and second visible mechanical indictors 190 and 192 are preferablyarranged on the top of respective housing portions 102 and 104.Indicator 190 preferably provides a visible indication of the extentthat arcuate tunneling needle 148 is displaced from its fully retractedposition shown in FIGS. 1A & 1B. Indicator 192 preferably provides avisible indication of the extent that hollow bone engagement elementdriving shaft 156 and rotatable bone engagement element 158 aredisplaced forwardly with respect to their fully retracted positionsshown in FIGS. 1A & 1B.

Reference is now made to FIGS. 2A & 2B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-1B and 12,showing opposite views in a second operative orientation. It is seenthat in the second operative orientation, which preferably takes placefollowing insertion of the device through an arthroscopic incision, asdescribed hereinbelow in detail with reference to FIG. 22B, the hollowbone engagement element driving shaft 156 and the rotatable boneengagement element 158 are extended relative to their fully retractedpositions shown in FIGS. 1A & 1B, as indicated by indicator 192.

Reference is now made to FIGS. 3A & 3B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-2B and 12in a third operative orientation. It is seen that hollow bone engagementelement driving shaft 156 and the rotatable bone engagement element 158are further extended, as indicated by indicator 192, and that rotatablebone engagement element 158 is partially rotated relative to itsposition shown in FIGS. 2A & 2B. This rotation of the rotatable boneengagement element 158 is initially produced by forward lineardisplacement of bone-engaging pin driving assembly 120, preferablyincluding knurled knob 122 and elongate bone-engaging pin 124, throughhollow bone engagement element driving shaft 156, such that forward end126 engages rotatable bone engagement element 158 and causes it to pivotabout axis 164.

Reference is now made to FIGS. 4A & 4B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-3B and 12in a fourth operative orientation. It is seen that the rotatable boneengagement element 158 is now further extended and fully rotated byapproximately 90 degrees relative to its position shown in FIGS. 2A &2B. It is seen that bone engagement pin 124 is further extended by thefurther forward linear displacement of knob 122 relative to housingportions 102 and 104. This rotation of the rotatable bone engagementelement 158 is produced by further forward linear displacement ofbone-engaging pin driving assembly 120 and by the tension applied byresilient suture mounting element 182 to suture 172, which engagesrotatable bone engagement element 158.

Reference is now made to FIGS. 5A & 5B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-4B and 12in a fifth operative orientation. It is seen that the hollow boneengagement element driving shaft 156 and the rotatable bone engagementelement 158 are both yet further extended. It is also seen that boneengagement pin 124 is further extended to its maximum extent asindicated by the position of knob 122 relative to housing portions 102and 104.

Reference is now made to FIGS. 6A & 6B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-5B and 12in a sixth operative orientation. It is seen that the rotatable boneengagement element 158 and the bone engagement pin 124 remain in theirmaximum extended positions, as shown in FIGS. 5A & 5B, and that arcuatetunneling needle 148 is partially extended, as indicated by indicator190.

Reference is now made to FIGS. 7A & 7B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-6B and 12in a seventh operative orientation. It is seen that the rotatable boneengagement element 158 and the bone engagement pin 124 remain in theirmaximum extended positions, as shown in FIGS. 5A & 5B, and that arcuatetunneling needle 148 is nearly fully extended, as indicated by indicator190.

Reference is now made to FIGS. 8A & 8B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-7B and 12in an eighth operative orientation. It is seen that the rotatable boneengagement element 158 and the bone engagement pin 124 remain in theirmaximum extended positions, as shown in FIGS. 5A & 5B, and that arcuatetunneling needle 148 is fully extended, as indicated by indicator 190.It is seen that the forward end 174 of suture 172 is now engaged insuture engagement groove 149 of needle 148.

Reference is now made to FIGS. 9A & 9B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-8B and 12in a ninth operative orientation. It is seen that the positions of knobs146 in slots 136 are shifted downwardly, in order to provide retractionof needle 148 in response to ratchet operation. The rotatable boneengagement element 158 and the bone engagement pin 124 remain in theirmaximum extended positions, as shown in FIGS. 5A & 5B, and arcuatetunneling needle 148 is partially retracted, as indicated by indicator190, in engagement with the forward end of suture 172, thus drawing thesuture 172 backwards along with retraction of the needle 148 along anarcuate path earlier defined through the bone by the arcuate tunnelingoperation of needle 148.

Reference is now made to FIGS. 10A & 10B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-9B and 12in a tenth operative orientation. The rotatable bone engagement element158 and the bone engagement pin 124 remain in their maximum extendedpositions, as shown in FIGS. 5A & 5B, and arcuate tunneling needle 148is fully retracted as indicated by indicator 190, in engagement with theforward end of suture 172, thus drawing the suture backwards along anarcuate path along with full retraction of the needle 148.

Reference is now made to FIGS. 11A & 11B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-10B and 12in an eleventh operative orientation. The rotatable bone engagementelement 158 and the bone engagement pin 124 have been fully retractedand arcuate tunneling needle 148 is now partially extended in order topermit manual disengagement of the forward end 174 of suture 172 fromgroove 149 of needle 148. It is noted that the positions of knobs 146 inslots 136 are shifted upwardly, in order to provide extension of needle148 in response to ratchet operation. The orientations of the variouselements are shown by indicators 190 and 192.

Reference is now further made to FIG. 12 and additionally made to FIGS.13A and 13B, which are simplified exploded view illustrations of aportion of the arthroscopic surgical device of FIGS. 1A-12, showingopposite views, and to FIG. 13C, which is a simplified partiallyassembled view, all of which show details of some elements of multipleaction driving assembly 106.

It is seen that ratchet handle 130 is typically formed with a loweraperture 210 which accommodates shaft 134 and is formed with a slot 212.A pin 214 is slidably movable in slot 212, such that reciprocal arcuatemotion of slot 212 is translated into reciprocal planar forward andrearward motion perpendicular to a longitudinal axis 216 of pin 214.First and second reciprocal motion connection elements 220 and 222 arefixed to pin 214 at respective apertures 224 and 226 and move togethertherewith in reciprocal forward and rearward linear motion in responseto rotational motion of ratchet handle 130.

Connection element 222 includes an elongate protrusion 228, which movesreciprocally in a slot 230 formed in housing portion 102.

Connection element 220 includes a side extending shaft 240 whichincludes a circumferential groove 244 onto which is mounted one end of atension spring 248. An opposite end of tension spring 248 is mounted ina circumferential groove 250 formed in shaft 135. Shaft 135 extendsthrough an aperture 254 formed in a toggle element 256, whichcommunicates with a hollow shaft portion 258 of toggle element 256.Shaft 135 extends through slots 136 formed on respective housingportions 102 and 104.

A double rack linear toothed element 270 is provided with an upperlinear toothed ratchet rack 272 and a lower linear toothed gear rack274. A pointed corner 275 of connection element 220 selectably engagesupper linear toothed rack 272. Double rack linear toothed element 270 ispreferably formed with a slot 276 which engages an elongate axialprotrusion 277 formed in housing element 102.

An inward recessed portion 278 adjacent an inner end of a generallyrigid flexible needle driving strip driving shaft 280 is fixedly mountedonto double rack linear toothed element 270 by means of a mountingelement 282 which is typically bolted onto element 270. An indicatorfinger 284 is formed on mounting element 282 and forms part of indicator190.

A second double rack linear toothed element 285 is provided with anupper linear toothed gear rack 286 and a lower linear toothed ratchetrack 287. Double rack linear toothed element 285 is preferably formedwith a slot 288 which engages an elongate axial protrusion 289 formed inhousing element 102.

A gear 290, having a gear shaft 291, engages lower linear toothed gearrack 274 of element 270 and also simultaneously engages upper lineartoothed gear rack 286 of element 285. Gear shaft 291 preferably ismounted at its opposite ends in apertures 292 in respective housingelements 102 and 104.

A pointed corner 293 of connection element 220 selectably engages lowerlinear toothed ratchet rack 287 of element 285.

It is seen that trigger 152 forms part of a selectable release element294, which forms part of assembly 150 and includes a engagementprotrusion 295 and collar 296 through which extends gear shaft 291.Selectable release element 294 is pivotable about the axis of gear shaft291 and includes a protrusion 297 which serves as a seat for one end ofa compression spring 298, whose other end is seated in a spring seat 299formed in housing portion 102.

A linear gear rack element 300 is preferably driven along an lineartravel path by a gear 301, having a gear shaft 302, which extendsthrough respective housing portions 102 and 104 into fixed engagementwith knobs 154. Gear 301 is normally prevented from clockwise rotationby engagement therewith by engagement protrusion 295 of selectablerelease element 294. A mounting assembly 303 is fixed to linear gearrack element 300 and is operative to fixedly mount a rearward end ofhollow bone engagement element driving shaft 156 onto element 300 forlinear movement therewith. An indicator finger 304 is also preferablyfixedly mounted onto mounting assembly 303 and forms part of indicator192.

Preferably, mounting assembly 303 is formed with a pair of oppositelydirected elongate protrusions 305 which engage corresponding grooves 306formed in housing portions 102 and 104.

Reference is now made to FIGS. 14A-16B, which illustrate needle andsuture mounting assembly 170. The needle and suture mounting assembly170 includes linear gear rack element 300, which is preferably drivenalong an elongate travel path by gear 301 responsive to rotation ofeither of knobs 154.

Suture mounting adaptor 183 is seated on mounting base 185, a rearwardend of which is, in turn, fixed to a forward end of the housing.Mounting base 185 surrounds a rearward end of an extension shaft 310formed of two identical side by side pieces 311 which together definetwo mutually spaced axial mounting bores extending therethrough, whichbores are designated by reference numerals 312 and 314. Bore 312slidably accommodates hollow bone engagement element driving shaft 156and has a generally round cross-section.

Bore 314 slidably accommodates parts of a flexible arcuate needledriving assembly, which preferably includes a flexible needle drivingstrip 318, preferably formed of spring steel, and generally rigidflexible needle driving strip driving shaft 280, which is mounted at therear of flexible needle driving strip 318, preferably as shown inenlargement A in FIG. 14B. As seen in enlargement B in FIG. 14B, bore314 has a generally circular cross sectional portion 322 to accommodateshaft 280 from which extend a pair of symmetrical side cut outs 324 toaccommodate the side edges of strip 318.

Forward of extension shaft 310, there is preferably formed an arcuateneedle storage and guiding portion 350, which is formed with an arcuatebore 352 including a rectangular portion 354, which slidablyaccommodates needle 148, from which extend a pair of symmetrical sidecut outs 356 to accommodate the side edges of strip 318.

As seen particularly in FIG. 15A, it is seen that suture engagementgroove 149 of arcuate needle 148 is partially defined by a partiallyoverlying portion 357 of needle 148.

It is seen that bone engagement pin 124 slidably extends through boneengagement element driving shaft 156, which in turn slidably extendsthrough bore 312.

Reference is now made to FIGS. 17A and 17B, which are respectiveexploded and assembled views of the rotatable bone engagement element158, which forms part of the portion of the arthroscopic surgical deviceof FIGS. 14A & 14B, and to FIG. 17C, which is a sectional illustrationof the rotatable bone engagement element 158, taken along lineXVIIC-XVIIC in FIG. 17B.

As seen in FIGS. 17A-17C, the rotatable bone engagement element 158 is aside-to-side symmetric element including side wall portions 402 and 404joined by a bridging portion 406. Each of the side wall portions 402 and404 includes a protruding top pointed bone engaging portion 408, aprotruding bottom pointed bone engaging portion 410 and an aperture 412for rotatably accommodating pin 160. An arcuate slot 416 is formed ineach side wall. Slots 416 together define groove 176 (FIGS. 1A & 1B)which is partially engaged by the forward end 174 of suture 172. Aninwardly directed protrusion 418 is formed on an inner wall surface ofeach of side wall portions 402 and 404.

A flexible bent plate 420 is preferably attached at a top portion 422 toa rear facing surface of bridging portion 406 and is arranged to have aforwardly directed bottom portion 424 normally seated between side wallportions 402 and 404 so as to partially block access to arcuate slots416 by the forward end 174 of suture 172.

Reference is now made to FIG. 18A, which is a pictorial illustration ofmounting base 185, another part of the portion of the arthroscopicsurgical device of FIGS. 14A & 14B, and to FIG. 18B, which is asectional illustration taken along line XVIIIB-XVIIIB in FIG. 18A. Asseen in FIGS. 18A & 18B, the mounting base 185 is a generallycylindrical element having a longitudinal bore 440 extendingtherethrough, which accommodates the rearward end of extension shaft310.

Reference is now made to FIGS. 19A, 19B and 19C, which are simplifiedillustrations of one alternative structure and functionality formounting of a suture on a resilient loop which is in turn mounted on aforward portion of the arthroscopic surgical device of FIGS. 1A-12.

As seen in FIGS. 19A-19C, there is preferably provided a suture mountingassembly including suture 172, resilient suture mounting element 182 andsuture mounting adapter 183, which is adapted for removable mountingonto mounting base 185 (FIGS. 18A-18B). Suture mounting element adapter183 preferably is configured generally as a cap which is removablyseated onto mounting base 185. Suture mounting element adapter 183preferably includes a rearward facing resilient engagement element 442which is snap engageable with circumferential groove 184 of mountingbase 185.

FIG. 19A shows the various elements prior to assembly thereof and FIG.19B shows the suture 172 knotted onto the resilient suture mountingelement 182. FIG. 19C shows the resilient suture mount element 182,having the suture 172 knotted thereon, retained onto hook 310 of suturemounting element adapter 183.

Reference is now made to FIGS. 20A, 20B and 20C, which are simplifiedillustrations of another alternative structure and functionality formounting of a suture on a resilient loop which is in turn mounted on aforward portion of the arthroscopic surgical device of FIGS. 1A-12.

As seen in FIGS. 20A-20C, there is preferably provided a suture mountingassembly including a endless looped suture 450, resilient suturemounting element 182 and suture mounting adapter 183, which is adaptedfor removable mounting onto mounting base 185 (FIGS. 18A-18B). As in theembodiment of FIGS. 19A-19C, suture mounting element adapter 183preferably is configured generally as a cap which is removably seatedonto mounting base 185 and preferably includes a rearward facingresilient engagement element 442 which is snap cngageable withcircumferential groove 184 of mounting base 185.

FIG. 20A shows the various elements prior to assembly thereof and FIG.20B shows the suture 450 looped over the resilient suture mountingelement 182. FIG. 20C shows the resilient suture mount element 182,having the suture 450 knotted thereon, retained onto book 310 of suturemounting element adapter 183.

Reference is now made to FIGS. 21A, 21B, 21C, 21D, 21E, 21F, 21G, 21H,21I, 21J, 21K, 21L, 21M and 21N, which illustrate details of theoperation of the arthroscopic surgical device of FIGS. 1A-20C, and toFIGS. 22A, 22B, 23C, 23D, 23E, 23F, 23G, 22H, 22I, 22J, 22K, 22L, 22Mand 22N, which are simplified illustrations of operation of thearthroscopic surgical device of FIGS. 1A-21N in a clinical context.

As seen in FIGS. 21A and 22A, which correspond generally to FIGS. 1A &1B, prior to insertion of the arthroscopic surgical device 100 throughan arthroscopic incision 500 in a patient, a suture mounting assembly170, such as that described hereinabove with reference to FIGS. 19A-19C,is mounted onto the arthroscopic surgical device 100, with a forward end174 of the suture 172 being retained in slots 416 (FIGS. 17A-17C)defining groove 176 (FIGS. 1A & 1B) of bone engagement element 158.

FIG. 22B shows insertion of a forward portion of arcuate needle storageand guiding portion 350 through incision 500 such that a forwardmost end502 of arcuate needle storage and guiding portion 350 engages a bone,here shown as a humerus.

It is seen in FIGS. 21A, 22A & 22B that the bone engagement pin 124 anda hollow bone engagement element driving shaft 156 are in their fullyretracted positions and that knobs 146 are in their upward positions inslots 136. As seen in FIG. 22B, indicator 190 shows full retraction offlexible needle driving strip driving shaft 280 and of arcuate tunnelingneedle 148 and indicator 192 shows full retraction of hollow boneengagement element driving shaft 156 and of bone engagement element 158.As further shown in FIGS. 21A, 21B & 22B, knobs 146 are positioned totheir upper operative orientation in slots 136, for forward directiondriving of arcuate tunneling needle 148.

FIGS. 21B and 22C, which correspond generally to FIGS. 2A & 2B, showcounterclockwise rotation of knobs 154, in the sense of FIG. 21B, asindicated by an arrow 504 in FIG. 21B. This counterclockwise rotation,as seen particularly in enlargement A in FIG. 21B, producescorresponding counterclockwise rotation of gear 301, as indicated by anarrow 506, in engagement with linear gear rack element 300, drivinglinear gear rack element 300 forwardly in the sense of FIG. 21B, asindicated by an arrow 507.

As noted above with reference to FIGS. 12-13C, mounting assembly 303fixes hollow bone engagement element driving shaft 156 onto element 300for linear movement therewith. Thus, forward motion of linear gear rackelement 300 produces corresponding forward extension of hollow boneengagement element driving shaft 156, as can be seen by comparingenlargement A of FIG. 21B with corresponding enlargement A of FIG. 21A.

Enlargements B in FIGS. 21B, 21C, 21D and 21E, which correspondgenerally to FIGS. 2A-5B, show various stages in rotation of rotatablebone engagement element 158 about axis 164 and forward displacement ofknurled knob 122 and elongate bone-engaging pin 124, extending forwardlytherefrom.

FIG. 22C, which corresponds generally to FIGS. 4A & 4B, shows extensionof hollow bone engagement element driving shaft 156 and rotation ofrotatable bone engagement element 158 about axis 164 defined by pin 160into operative engagement with the bone. Indicator 190 is unchanged fromits position shown in FIG. 22B, indicating that the arcuate needle 148remains in its fully retracted position. Indicator 192 shows theextension of hollow bone engagement element driving shaft 156 as can beseen by comparing the positions of indicator finger 304 in FIGS. 22B and22C respectively.

FIG. 22D, which corresponds generally to FIGS. 5A & 5B, shows that theoptionally threaded portion 128 at the forward end 126 of boneengagement pin 124 is fully engaged with the bone, preferably as by bothlinear and rotational movement thereof, as indicated by the position ofknob 122 and by an arrow 510 relative to housing portions 102 and 104.

FIGS. 21F and 21G and FIG. 22E, which correspond generally to FIGS. 6A &6B, show partial extension of arcuate tunneling needle 148 through thebone, as indicated by indicator finger 284 of indicator 190.

FIGS. 21E, 21F, 21G & 21H, particularly at enlargements C thereof, showthat squeezing on hand-engageable ratchet handle 130 produces rotationthereof, as indicated by an arrow 518, about a rotational axis definedby shaft 134 and, via pin 214, displaces first reciprocal motionconnection element 220 linearly forwardly, as indicated by an arrow 520,with pointed corner 275 of connection element 220 in engagement withupper linear toothed rack 272 of double rack linear toothed element 270,thereby driving element 270 and flexible needle driving strip drivingshaft 280 forwardly and causing arcuate needle 148, driven thereby, totravel along an arcuate path through the portion of arcuate bore 352having a rectangular cross section and to extend outwardly intotunneling engagement with the bone, as indicated by arrow 522.

FIG. 21G shows retraction of handle 130, as indicated by an arrow 530,under urging of spring 248 whereby pointed corner 275 is operationallydisengaged from rack 272 of double rack linear toothed element 270, suchthat one or more subsequent squeeze on handle 130, as indicated by anarrow 526, produces further linear forward motion of double rack lineartoothed element 270 and consequent further arcuate extension travel ofneedle 148, as seen in FIG. 21H.

It is appreciated that simultaneous engagement of gear 290 with lowerlinear toothed gear rack 274 of element 270 and upper linear toothedgear rack 286 of element 285 produces rearward linear motion of element285 corresponding to forward linear motion of element 270.

FIGS. 21H and 22F, which correspond generally to FIGS. 7A & 7B, showfurther arcuate extension of arcuate tunnel needle 148, as indicated byan arrow 534, through the bone, driven by further squeezing of handle130, as well as initial engagement of a forward end of needle 148 withflexible bent plate 420 of the bone engagement element 158.

FIGS. 21I & 22G, which correspond generally to FIGS. 8A & 8B, shownearly complete extension of arcuate tunnel needle 148 in engagementwith flexible bent plate 420 and bending back of flexible bent plate 420so as to disengage bottom portion 424 thereof from the forward end 174of suture 172. It is noted that forward end 174 of suture 172 does notmove further into suture engagement groove 149 of needle 148 because itis blocked by a partially overlying portion 357 of needle 148 whichpartially defines groove 149 of needle 148.

FIG. 22H, which corresponds generally to FIGS. 8A & 8B, shows completeextension of arcuate tunnel needle 148. It is noted that the forward endof suture 172 moves into groove 149 of needle 148, by the resilientaction of resilient suture mounting element 182, and is engaged byneedle 148. The complete extension of arcuate tunnel needle 148 isindicated by indicator finger 284 of indicator 190.

FIGS. 21J, 22I and 22J, which correspond generally to FIGS. 9A & 9B,show initial retraction of arcuate tunnel needle 148, as indicated byarrows 535, following repositioning of knobs 146, as indicated by anarrow 536, which produces reverse driving of the ratchet assemblyoperated by squeezing handle 130. It is noted that the needle 148carries with it the suture 172.

Repositioning of knobs 146 causes repositioning of connection element220, as indicated by an arrow 538, causing pointed corner 293 ofconnection element 220 to engage lower linear toothed ratchet rack 287of element 285, as seen in FIG. 21J, such that squeezing of handle 130,as indicated by an arrow 539, causes element 285 to be moved linearlyforward. It is appreciated that simultaneous engagement of gear 290 withlower linear toothed gear rack 274 of element 270 and upper lineartoothed gear rack 286 of element 285 produces rearward linear motion ofelement 270 in response to forward linear motion of element 285.

FIG. 22K, which corresponds generally to FIGS. 10A & 10B, shows furtherretraction of arcuate tunnel needle 148. It is noted that the needle 148continues to draw the suture 172 with it.

FIGS. 21K and 22L, which correspond generally to FIGS. 11A and 11B, showretraction of arcuate tunnel needle 148 entirely out of the bone. It isnoted that the needle 148 continues to draw the suture 172 therewith.

FIG. 21L shows rearward pivot displacement of finger-engageable releasetrigger 152, as indicated by an arrow 540, against the urging ofcompression spring 298, and simultaneous clockwise rotation of knob 154.Rearward pivot displacement of release trigger 152 causes selectablerelease element 294 to rotate counterclockwise, as indicated by arrow541, about the axis of gear shaft 291, thereby producing disengagementof engagement protrusion 295 of element 294 from gear 301, thus enablinggear 301 to be rotated by knob 154 in a clockwise direction, asindicated by an arrow 542, which in turn produces retraction of hollowbone engagement element driving shaft 156.

FIG. 21M shows full retraction of bone engagement pin 124.

FIG. 22M shows full removal of the arthroscopic surgical device from thepatient's body via the arthroscopic incision 500, with the suture 172extending through the bone.

FIG. 21N shows slight extension of the needle 148 to enable manualdisengagement of the suture 172 from groove 149 therein. This extensionis produced by upward repositioning of knobs 146 in slots 136 andsqueezing of handle 130.

FIG. 22N shows manual release of the forward part 174 of suture 172 fromsuture engagement groove 149 of needle 148.

It will be appreciated by persons skilled in the art that the presentinvention is not limited by what has been particularly shown anddescribed hereinabove. Rather the scope of the present inventionincludes both combinations and subcombinations of the various featuresdescribed hereinabove as well as modifications thereof which would occurto persons skilled in the art upon reading the foregoing description andwhich are not in the prior art.

The invention claimed is:
 1. An arthroscopic surgical device for tunneling through hard tissue comprising: an arcuate tunneling needle; and an at least partially flexible arcuate tunneling needle driver for driving said arcuate tunneling needle, said at least partially flexible arcuate tunneling needle driver comprising: a hand-engageable ratchet handle arranged for reciprocal motion about an axis; a selectable direction ratchet gear driven by said ratchet handle; and a needle pushing element, driven by said ratchet gear, which is capable of assuming an arcuate orientation during needle driving operation thereof.
 2. An arthroscopic surgical device for tunneling through hard tissue according to claim 1 and also comprising a bone engaging pin driving assembly including an elongate bone engaging pin.
 3. An arthroscopic surgical device for tunneling through hard tissue according to claim 2 and wherein said bone engaging pin includes a tapered screw threading.
 4. An arthroscopic surgical device for tunneling through hard tissue according to claim 1 and wherein said arcuate tunneling needle driver includes: a flexible needle driving strip; and a generally rigid flexible needle driving strip driving shaft, mounted at a rear end of said flexible needle driving strip.
 5. An arthroscopic surgical device for tunneling through hard tissue according to claim 1 and also comprising an arcuate needle storage and guiding portion, formed with an arcuate bore.
 6. An arthroscopic surgical device for tunneling through hard tissue according to claim 1 and also comprising a housing portion including a pair of gear shaft slots, and wherein a gear shaft of said selectable direction ratchet gear extends through said pair of gear shaft slots.
 7. An arthroscopic surgical device for tunneling through hard tissue according to claim 6 and also comprising a pair of knobs attached to ends of said gear shaft, wherein a position of said pair of knobs in said pair of gear shaft slots governs a direction of motion of said arcuate tunneling needle. 